Elementary, Middle or High School College, University, or Trade School COMPANY NAME: WinnResidential Phone: (202) 561-8600 4319 Third Street SE, Suite 200 Fax: (202) 516-8054 Washington, DC 20032 Email: atlanticterrace@winnco.com RENTAL APPLICATION NAME: HOME PHONE: Management Initials: CELL PHONE: Date/Time Recieved: WORK PHONE: EMAIL: ADDRESS: INSTRUCTIONS TO APPLICANT º ALL lines must be filled in. You may write "NONE" or "NO" in a line, but DO NOT leave a line blank or write N/A. º All information must be complete and correct. False, incomplete or misleading information will cause your application to be declined. º If you need to make a correction, put one line through the incorrect information, write the correct information above, and initial the change. HOUSEHOLD INFORMATION Student Y/N Full Name of Household Members as they appear on SS Card Relationship Date of Birth Social Security No. or Alien Registration No. SS Benefit Claim Number for anyone receiving benefits from Social Security Age 1. Head 2. 3. 4. 5. 6. 1. Will any of the household members listed above live anywhere except in your apartment? If YES, Explain: 2. Are any children listed above subject to a shared custody agreement? Is YES, explain: 3. Is any household member a foster child or foster adult? 4. If YES, list member(s): If YES, explain 5. Will any member of your household require a unit having handicap accessible features? If YES, type of accessibility required: Are there any special accommodations that the household will require in order to enjoy equal opportunity to 6. use and enjoy the apartment? If YES, explain: 7. Is any member of your household enrolled in an Institute of Higher Education, either full or part-time? If YES, list member(s): 8. Is any household member a U.S. Veteran? If YES, list houshold member (s) 9. Have you been displaced from your housing? If YES, was it a Presidentially Declared Disaster Area? 10. Do you expect any additions to the household within the next 12 months? 12. Have you or any other member of your household ever used any name(s) or social security number(s) other than the one you are currently using? If YES, list reason: Government Action Private Action Natural Disaster If YES, list reason: Pregnancy Adoption Foster Care Other Is any member of your household an individuals age 62 or older as of January 31, 2010 who was receiving HUD rental assistance on January 31, 2010? These individuals may be exempt from providing Social Security Numbers. Application Page 1 of 7 No No Yes Yes
RESIDENCE HISTORY You must report ALL places you have lived for the past five (5) years. Use an additional sheet if necessary. Periods of homelessness may be explained on a separate sheet of paper. Present I currently: [ ] Rent this residence [ ] Own this residence [ ] Live with a renter at this residence [ ] Live with the owner of this residence From: Landlord Name: Was this Federally Assisted Housing? Yes No Amount of Rent State: Zip: From: Landlord Name: Was this Federally Assisted Housing? Yes No Amount of Rent State: Zip: From: Landlord Name: Was this Federally Assisted Housing? Yes No Amount of Rent State: Zip: From: Landlord Name: Was this Federally Assisted Housing? Yes No Amount of Rent State: Zip: From: Landlord Name: Was this Federally Assisted Housing? Yes No Amount of Rent State: Zip: You must report All states that All household members have lived in. This includes the District of Columbia. States Household Members That Lived There States Household Members That Lived There 1. Have you or any member of your household ever been evicted from federally assisted housing for drug-related activity? Circle One If 'Yes' you must answer the following: From Where? When? 2. Have you or any member of your household been evicted in the last five years? (For any reason) No Yes From Where? When? 3. 4. 5. Do you or any member of your household owe money to any Public To Whom? Housing Authority, HUD, Apartment Community or Landlord? How much? Have you or any member of your household ever committed any fraud Explain: in a Federally Assisted Housing Program or been asked to repay money for knowingly misrepresenting information for such housing programs? Please check any that apply to your current housing: [ ] Lacking a fixed nighttime residence [ ] Without or soon to be without housing [ ] Standard [ ] Substandard [ ] Conventional Public Housing 6. From what source did you hear about this property? [ ] Resident [ ] DCHousingSearch.org [ ] Sign at Property [ ] Newspaper: [ ] Agency: [ ] Website: [ ] Other Application Page 2 of 7
SOURCES OF INCOME You must report income from ALL sources. This includes, but is not limited to, Employment, Public Assistance, Social Security, SSI Disability Compensation, Unemployment Compensation, Workers Compensation, Retirement Benefits, Veterans Benefits, Child Support, Alimony, Educational Grants, Scholarships, etc. If anyone outside your household gives you money or pays your bills, you must report it as a source of income. Use additional sheets if necessary. Household member the income is paid to: Name of Supervisor or Agency Contact: Start Date: : State: Zip: per (hr/wk/mo/yr/etc.) Household member the income is paid to: Name of Supervisor or Agency Contact: Start Date: : State: Zip: per (hr/wk/mo/yr/etc.) Household member the income is paid to: Name of Supervisor or Agency Contact: Start Date: : State: Zip: per (hr/wk/mo/yr/etc.) Household member the income is paid to: Name of Supervisor or Agency Contact: Start Date: : State: Zip: per (hr/wk/mo/yr/etc.) Application Page 3 of 7
ASSET INFORMATION You must report ALL Assets below. Use an additional sheet if necessary. This includes, but is not limited to: Cash; Checking, Savings, Debit, Pay Card, Money Market, and Certificate of Deposit accounts; Stocks; Bonds; Mutual Funds; Trust Funds; Retirement Accounts; Life Iinsurance; Personal Property held as an investment; Real Estate; etc. State: Zip Bank State: Zip Bank State: Zip Bank State: Zip Bank State: Zip Bank State: Zip Bank State: Zip Bank 1. Has any household member disposed of (given away or sold) an asset for less than what is was worth (fair market value) in the past two (2) years? If 'Yes' you must answer the following: Date Disposed of: / / Description of Asset: 2. Has any household member sold any Real Estate in the last two years? 3. Does any household member have full or partial ownership of any Real Estate, Boat or Mobile Home? Date Disposed of: / / Description of Asset: Sales Price: Description of Asset: Value: Annual Income from Asset: Application Page 4 of 7
WORKING PREFERENCE FOR THE WAIT LIST The Wait List has a preference for working families. Working families means a family whose head of household, spouse, co-head of household, or sole member is working full time, 62 years of age or older, or disabled. [ ] My household qualifies for the working preference because the head of household, co-head of household, spouse, or sole member is: [ ] Working full time (minimum of 32 hours per week and employed at the same company for at least six (6) months) List the number of hours worked per week: [ ] 62 years of age or older [ ] Disabled as defined by HUD [ ] My household does not qualify for this preference If you pay for Child Care, please list name of provider(s) below. Phone: State: Zip CHILD CARE EXPENSES Phone: State: Zip If you pay for care of Handicapped or Disabled household member, list name of provider(s) below. Phone: State: Zip Phone: State: Zip HANDICAP CARE EXPENSES AUTOMOBILES AND OTHER VEHICLES List all motor vehicles, including motorcycles, owned by or registered to household members. Use additional sheets if necessary. Make: License Plate Number: State Insurance Agent: Phone: Model: License Expiration Date: Policy No: Color: Year: Name on Registration: State Zip Expiration Date: Make: License Plate Number: State Insurance Agent: Phone: Model: License Expiration Date: Policy No: Color: Year: Name on Registration: State Zip Expiration Date: It is not required, but we recommend that you carry Renters Insurance. Your personal belongings are not covered by our insurance. If you have coverage, please provide information below. Insurance Agent: RENTERS INSURANCE Phone: Policy No: State: Zip: Expiration Date: Application Page 5 of 7
ELDERLY/HANDICAPPED/DISABLED STATUS We are required by HUD to request the following information for the purpose of determining eligibility for admission to our Section 8 Program and/or to give special considerations with regard to allowances in determining rent. Please review the attached HUD definition of disability. Check any answer that applies. Head of Household is: 62 years of age or older Handicapped Disabled None apply Co-Head of Household and/or Spouse is: Co-Head of Household is: 62 years of age or older Handicapped Disabled None apply 62 years of age or older Handicapped Disabled None apply We are required by HUD to obtain the following information for the purposes of statistical reporting. Response is strictly voluntary. Does any family member have one of the following disabilities? Mobility Visual Hearing If the Head or Spouse is 62+ Years of Age or is Disabled/Handicapped, please fill out the Medical Expenses section below including all family members. [ ] This section does not apply to my household. Description of Expense: Phone: Policy No: State: Zip Description of Expense: Phone: Policy No: State: Zip Description of Expense: Phone: Policy No: State: Zip MEDICAL EXPENSES Description of Expense: Phone: Policy No: State: Zip This property's eligibility criteria excludes housing to individuals and households with specific types of criminal activity in their history. You must answer the following questions completely and truthfully. If any of the answers are false, misleading or incomplete your application may be rejected, OR, if move-in has occurred, you may be evicted. If 'Yes' you must answer the following: 1. Have you or any member of your household ever been convicted Who? When? of drug-related criminal activity? 2. Have you or any member of your household ever been convicted Who? When? of violent criminal activity? 3. Are you or any member of your household a current, illegal user of or Who? When? addicted to a controlled substance? 4. Are you or any member of your household a current user of or Who? When? addicted to marijuana? 5. Do you or any member of your household have a pattern of alcohol abuse? CRIMINAL HISTORY Who? 6. Have you or any member of your household ever been convicted of Who? When? the illegal manufacture or distribution of a controlled substance? 7. Have you or any member of your household ever been on parole or Who? When? are now on parole? 8. Have you or any member of your household currently or in the past used Who? When? illegal drugs? 9. Are you or any member of your household subject to a state sex Who? When? offender lifetime registration requirement? In What State? County? Application Page 6 of 7
Read each statement below and initial that you understand and agree. APPLICANT CERTIFICATION I have read and understand the information in this application, in particular the instructions to Applicant, and agree to comply with all information and instructions. I have read and understand the Tenant Selection Plan, that is posted in the Management Office and summarizes the procedures for processing applications. I certify that all information given in this application is true, complete and accurate. I understand that if any of this information is false, misleading or incomplete, Management may decline my application, OR, if move-in has occurred, terminate my lease and evict me and my household. I understand that ALL CHANGES in the income of any member of the household, as well as any changes in the household members must be reported to Management in writing immediately. If my application is approved and move-in occurs, I certify that only those persons listed in this application will occupy the apartment, and that they will maintain no other place of residence. If this application is approved and move-in occurs, I certify that all household members will accept and comply with all conditions of occupancy as set forth therein, including rules regarding pets, rent, damages, and security deposits. I authorize Management to make any and all inquiries to verify this information either directly or through information exchanged now or later with rental and credit screening services, previous and current landlords, law enforcement agencies or other sources of information released to appropriate Federal, State or local agencies. I understand that it is a crime to knowingly provide false information for the purpose of obtaining or maintaining occupancy in and/or for the purpose of securing a lower rent in a subsidized housing development. I understand that the penalty for knowingly providing false information is up to five (5) years in prison and/or up to a 10,000 fine upon conviction. APPLICANT SIGNATURE DATE CO-APPLICANT SIGNATURE DATE WinnResidential does not discriminate on the basis of race, color, religion, national or ethnic origin, citizenship, ancestry, class, sex, sexual orientation, gender identity, familial status, marital status, disability or handicap, military/veteran status, source of income, age, or other basis prohibited by local, state or federal law. If you feel you have been discriminated against by this company, please call (617) 239-4596. This application is being placed on the following wait lists: Standard Apartments: [ ] Efficiency [ ] 1 Bedroom [ ] 2 Bedroom [ ] 3 Bedroom Apartments for Persons with a Mobility Impairment (Wheelchair Accessible): [ ] 1 Bedroom [ ] 2 Bedroom [ ] 3 Bedroom Apartments for Persons with a Hearing or Visual Impairment: [ ] 1 Bedroom [ ] 2 Bedroom [ ] 3 Bedroom Application Page 7 of 7